Provider Demographics
NPI:1629414024
Name:CASPER TREY WEBB, D.O.,P.A.
Entity Type:Organization
Organization Name:CASPER TREY WEBB, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASPER
Authorized Official - Middle Name:TREY
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-774-9322
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-0769
Mailing Address - Country:US
Mailing Address - Phone:817-774-9322
Mailing Address - Fax:817-774-9323
Practice Address - Street 1:1910 W HENDERSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4144
Practice Address - Country:US
Practice Address - Phone:817-774-9322
Practice Address - Fax:817-774-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096960203Medicaid
0084BQOtherBLUE CROSS BLUE SHIELD
010066348OtherRAILROAD MEDICARE
010066348OtherRAILROAD MEDICARE
TX096960203Medicaid